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  1. Please complete all fields. Omissions and/or false information are cause for rejection or dismissal.

  2. (xxx) xxx-xxxx

  3. (xxx) xxx-xxxx

  4. Example - Texas

  5. Punishment/Sentence/Deferred/Pending

  6. List all high schools, trade schools, or primary education schools

  7. List Major

  8. Please list any qualifications that may pertain to the job for which you are applying, such as bilingual skills, certification(s), etc.

  9. List all jobs beginning with your most recent employer.

  10. Current or Last Employer

  11. (xxx) xxx-xxxx

  12. Previous Employer

  13. (xxx) xxx-xxxx

  14. Previous Employer in Succession

  15. (xxx) xxx-xxxx

  16. Give name, address and telephone number of three references who are not related to you and are not previous employers.

  17. First Reference

  18. (xxx) xxx-xxxx

  19. Second Reference

  20. (xxx) xxx-xxxx

  21. Third Reference

  22. (xxx) xxx-xxxx

  23. I certify that the statements made by me in this application are true, complete, and correct to the best of my knowledge and are made by me in good faith. I understand that any misstatement or omission of material facts in this application (or in any information I have submitted or will submit) may be cause for rejection of this application or for my dismissal. I authorize investigation of my work history, driving history, criminal history, credit records, educational history, contact references and previous or current employers. I hereby release, indemnify, and hold harmless any government entity, employer, and person furnishing or receiving records and information about me.

  24. By printing your name on this form and submitting the application to the City of Mount Pleasant, you are certifying the information to be true and correct and submit to the Certification of Information and Release as stated above.

  25. Leave This Blank:

  26. This field is not part of the form submission.